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Although there is growing interest in telehealth to deliver parent-mediated intervention for autistic children, empirical evaluations are limited, and little is known regarding the relative benefits of self-directed and therapist-assisted telehealth interventions. This study examined the effect of self-directed and therapist-assisted ImPACT Online on parent learning and well-being, moderators of treatment, and predictors of program engagement. Sixty-four young autistic children and their primary caregiver participated. Children were matched on age and developmental quotient and randomly assigned to a therapist-assisted, self-directed, or resource support control group. Participants were assessed at intake, after 6 months (post), and at a 3-month follow-up. There was a significant treatment effect for parent learning for the therapist-assisted but not self-directed program; when analysis was limited to parents who completed the program, treatment effects were observed for both groups. There were no treatment effects for parent self-efficacy or parenting stress; however, there was an effect on parents' perception of their child's positive impact. Parenting stress did not moderate the effect of group on parent outcomes. Parent age, program satisfaction, and therapist assistance were all significant predictors of parent program engagement. This study supports the efficacy of therapist-assisted telehealth parent-mediated intervention for teaching parents intervention strategies to support their child's social communication and improving their perceptions of their child's positive impact, and suggests that self-directed programs may be beneficial for parents who fully engage with the program.

Joint attention and imitation are thought to facilitate a developmental cascade of language and social communication skills. Delays in developing these skills may affect the quality of children's social interactions and subsequent language development. We examined how responding to joint attention and object imitation skills predicted rate of expressive and receptive communication growth rate in a heterogeneous sample of autistic children. Children's baseline skills in responding to joint attention uniquely predicted expressive, but not receptive, language growth rate over time, while object imitation did not significantly predict language growth rate over and above joint attention skills. Future research should examine the potential moderating roles of child age and developmental level in explaining associations between joint attention and object imitation and later language development.

Naturalistic developmental behavioral interventions (NDBIs) are evidence-based interventions for young children with autism spectrum disorder. There has been growing interest in implementing manualized NDBIs within the early intervention (EI) system without a clear understanding of how these programs and the broader strategies encompassed within them are already used by EI providers. This study examined the use of manualized NDBI programs and broader NDBI strategies within an EI system and factors that impacted their use. Eighty-eight EI providers completed a measure of NDBI program and strategy use. Thirty-three providers participated in a supplemental focus group or interview. Overall, providers described using broader NDBI strategies and the need to adapt manualized NDBI programs. Provider-, intervention-, and organization-level factors impacted their use of NDBI programs and strategies.

The COVID-19 pandemic, and associated social distancing mandates, has placed significant limitations on in-person health services, requiring creative solutions for supporting clinicians engaged in the diagnosis of autism spectrum disorder (ASD). This report describes the five virtual instruments available at the time of manuscript development for use by experienced clinicians making diagnostic determinations of ASD for toddlers across the 12- to 36-months age range. We focus on synchronous virtual assessments in which clinicians guide the child's caregiver through a range of assessment activities and observe spontaneous and elicited behaviors. Assessments are compared on dimensions of targeted behavioral domains, specific activities and presses employed, scoring approaches, and other key logistical considerations to guide instrument selection for use in varied clinical and research contexts.

Parent training programs focus on parent knowledge and/or skill development regarding strategies to improve child outcomes. Parent training programs are considered evidenced-based treatments for autism spectrum disorder (ASD). Yet little is known about parent training use for youth with ASD served in community settings. This mixed methods project examined parent training for Medicaid-enrolled youth with ASD under age 21. Data were obtained from Medicaid claims for 879 youth and surveys from 97 applied behavior analysis (ABA) providers. Open-ended survey items were analyzed with content analysis. Results demonstrated that the frequency of parent training was low and providers' conceptualization of parent training was inconsistent with evidence-based models. Providers are largely unaware of evidence-based components (i.e., modeling, caregiver practice with feedback) and use them infrequently. Implications for increasing parent training in community settings are discussed.

Earlier autism diagnosis, the importance of early intervention, and development of specific interventions for young children have contributed to the emergence of similar, empirically supported, autism interventions that represent the merging of applied behavioral and developmental sciences. "Naturalistic Developmental Behavioral Interventions (NDBI)" are implemented in natural settings, involve shared control between child and therapist, utilize natural contingencies, and use a variety of behavioral strategies to teach developmentally appropriate and prerequisite skills. We describe the development of NDBIs, their theoretical bases, empirical support, requisite characteristics, common features, and suggest future research needs. We wish to bring parsimony to a field that includes interventions with different names but common features thus improving understanding and choice-making among families, service providers and referring agencies.

Despite the expansion of early intervention approaches for young children with ASD, investigators have struggled to identify measures capable of assessing social communication change in response to these interventions. Addressing recent calls for efficient, sensitive, and reliable social communication measures, the current paper outlines the refinement and validation of the Social Communication Checklist (SCC). We discuss two small studies exploring the psychometric properties of the SCC and the SCC-R (revised Social Communication Checklist), including sensitivity to change, inter-rater reliability, and test-retest reliability, in two samples of children with ASD and one sample of typically-developing children. Results indicate this measure is reliable, sensitive to change after a brief social communication intervention, and strongly related to well-established measures of social communicative functioning.

This study evaluated the psychometric properties of the Scale of Treatment Perceptions (STP), a measure of treatment acceptability targeting skill-building interventions for Autism Spectrum Disorder (ASD). This scale utilizes a strength-based approach to intervention assessment, and was established by modifying the Behavior Intervention Rating Scale (Elliott and Von Brock Treuting in "J School Psychol" 29(1):43-51, 1991. doi: 10.1016/0022-4405(91)90014-I) and the Treatment Evaluation Inventory (Kazdin in "J Appl Behav Anal" 13(2):259-273, 1980. doi: 10.1901/jaba.1980.13-259) to be appropriate for assessing multiple dimensions of acceptability across skill-building ASD treatments. Overall, the STP demonstrated good psychometric properties: the scale had appropriate internal consistency, demonstrated a stable three-factor structure that was invariant across samples, and discriminated among different skill-building treatments for ASD. This has important implications for dissemination, as perceived acceptability of a treatment relates to treatment utilization and adherence.

Systematic research focused on developing and improving strategies for the dissemination and implementation of effective ASD services is essential. An innovative and promising area of research is the use of telehealth programs to train parents of children with ASD in intervention techniques. A hybrid telehealth program, combining self-directed internet-based instruction with remote coaching, was created to introduce parents of children with ASD to an imitation intervention. A single-subject multiple-baseline design study evaluated the effect of the program on changes in parent and child behavior. Parents improved in their use of the intervention techniques and their children demonstrated concurrent increases in spontaneous imitation skills. Parents also indicated that the intervention and telehealth service delivery model were acceptable, useable, and effective. Results suggest that this hybrid telehealth program has the potential to increase access to ASD services.

This study compared sibling adjustment and relationships in siblings of children with Autism Spectrum Disorder (ASD-Sibs; n = 69) and siblings of children with typical development (TD-Sibs; n = 93). ASD-Sibs and TD-Sibs demonstrated similar emotional/behavioral adjustment. Older male ASD-Sibs were at increased risk for difficulties. Sibling relationships of ASD-Sibs involved less aggression, less involvement, and more avoidance than those of TD-Sibs. Partial support for a diathesis-stress conceptualization of sibling difficulties was found for ASD-Sibs. For TD-Sibs, broader autism phenotype (BAP) was related to psychosocial difficulties regardless of family stressors. For ASD-Sibs, BAP was related to difficulties only when family stressors were present. This suggests that having a sibling with ASD may be a protective factor that attenuates the negative impact of sibling BAP.

Frequency of high-level (showing/pointing) and low-level (coordinated gaze shifts) behaviors on the Early Social Communication Scales are often used as a measure of joint attention initiations (IJA). This study examined the degree to which these skills and response to joint attention (RJA; e.g. gaze following) were differentially related to measures of language and imitation in 53 children with autism spectrum disorder between the ages of 22 and 93 months. High-level and low-level IJA were not associated with each other, and only high-level IJA was associated with RJA, and language and imitation measures. High-level IJA and RJA were unique predictors of imitation, while RJA was a unique predictor of language. Findings indicate that IJA involves distinct skills, with high-level behaviors more closely related to social-communication skills.

Findings from research investigating goal-directed intention understanding in children with autism spectrum disorders (ASD) have been equivocal, in part because of the varying methodologies used across studies. This study compares both object-oriented and social-communicatively cued goal-directed intention understanding in children with ASD and typically-developing children. Relative to matched controls, children with ASD did not exhibit deficits in object-oriented intention understanding. While children with ASD also demonstrated the ability to understand intention when cued by social-communication indicators, typically-developing children differentiated between intentional and unintentional acts at a significantly greater level. Group differences in performance were eliminated if only trials in which children attended to the experimenter's face were considered. Results suggest that children with ASD have intact object-oriented intention understanding abilities, and are able to use social-communicative cues to understand intention. However, their ability to demonstrate social-communicatively cued intention understanding is limited by a lack of attention to relevant social-communicative information.

There is a need for the adaptation of training in evidence-based interventions to non-traditional methods, particularly for individuals working with children with autism spectrum disorders (ASD). An internet-based self-directed distance learning program was created to teach reciprocal imitation training, a naturalistic behavioral intervention aimed at increasing imitation in children with ASD. A single-subject multiple-baseline design study evaluated the effect of the program on changes in therapist (sample 1) and parent (sample 2) knowledge and behavior, and changes in child behavior. Adult participants improved their knowledge and use of the intervention techniques, and child participants improved their rates of imitation. Results suggest that a self-directed distance learning program may be effective for disseminating evidence-based practices to individuals working with children with ASD.

Joint attention may be a core deficit in autism which underlies the abnormal development of later emerging social-communication behaviors. Given this theory, researchers have suggested that teaching young children with autism to engage in joint attention may lead to collateral increases in other non-targeted social-communication behaviors. In this study, children with autism participated in a 10-week joint attention training program and collateral changes in non-targeted behaviors were assessed. Following participation in the intervention, positive collateral changes were observed in social initiations, positive affect, imitation, play, and spontaneous speech. Results support the hypothesis that teaching joint attention skills leads to improvement in a variety of related skills and have implications for the treatment of young children with autism.